Provider Demographics
NPI:1699960179
Name:PHAN, TUANH (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:TUANH
Middle Name:
Last Name:PHAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 COMMONWEALTH AVE APT 20
Mailing Address - Street 2:
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-3931
Mailing Address - Country:US
Mailing Address - Phone:617-232-9645
Mailing Address - Fax:
Practice Address - Street 1:1330 COMMONWEALTH AVE APT 20
Practice Address - Street 2:
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-3931
Practice Address - Country:US
Practice Address - Phone:617-232-9645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25749183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist